Restorative treatment decision making with unaided visual examination, intraoral camera and operating microscope

Evaluation of direct restorations using the revised FDI criteria: results from a reliability study

Objectives

The purpose of this in vitro reliability study was to determine the intra- and inter-examiner agreement of the revised FDI criteria including the categories “fracture of material and retention” (F1) and “caries at restoration margin” (B1).

Materials and methods

Forty-nine photographs of direct tooth-coloured posterior (n = 25) and anterior (n = 24) restorations with common deficiencies were included. Ten dental experts repeated the assessment in three blinded rounds. Later, the experts re-evaluated together all photographs and agreed on a reference standard. Statistical analysis included the calculation of Cohen’s (Cκ), Fleiss’ (Fκ), and weighted Kappa (wκ), the development of a logistic regression with a backward elimination model and Bland/Altman plots.

Results

Intra- and inter-examiner reliability exhibited mostly moderate to substantial Cκ, Fκ, and wκ values for posterior restorations (e.g. Intra: F1 Cκ = 0.57, wκ = 0.74; B1 Cκ = 0.57, wκ = 0.73/Inter F1 Fκ = 0.32, wκ = 0.53; B1 Fκ = 0.41, wκ = 0.64) and anterior restorations (e.g. Intra F1 Cκ = 0.63, wκ = 0.76; B1 Cκ = 0.48, wκ = 0.68/Inter F1 Fκ = 0.42, wκ = 0.57; B1 Fκ = 0.40, wκ = 0.51). Logistic regression analyses revealed significant differences between the evaluation rounds, examiners, categories, and tooth type. Both the intra- and inter-examiner reliability increased along with the evaluation rounds. The overall agreement was higher for anterior restorations compared to posterior restorations.

Conclusions

The overall reliability of the revised FDI criteria set was found to be moderate to substantial.

Clinical relevance

If properly trained, the revised FDI criteria set are a valid tool to evaluate direct and indirect restorations in a standardized way. However, training and calibration are needed to ensure reliable application.

Mouthwash as a non-invasive method of indocyanine green delivery for near-infrared fluorescence dental imaging

SIGNIFICANCE

X-ray imaging serves as the mainstream imaging in dentistry, but it involves risk of ionizing radiation.

AIM

This study presents the feasibility of indocyanine green-assisted near-infrared fluorescence (ICG-NIRF) dental imaging with 785-nm NIR laser in the first (ICG-NIRF-I: 700 to 1000 nm) and second (ICG-NIRF-II: 1000 to 1700 nm) NIR wavelengths.

APPROACH

Sprague Dawley rats with different postnatal days were used as animal models. ICG, as a fluorescence agent, was delivered to dental structures by subcutaneous injection (SC) and oral administration (OA).

RESULTS

For SC method, erupted and unerupted molars could be observed from ICG-NIRF images at a short imaging time (<1  min). ICG-NIRF-II could achieve a better image contrast in unerupted molars at 24 h after ICG injection. The OA could serve as a non-invasive method for ICG delivery; it could also cause the glow-in-dark effect in unerupted molars. For erupted molars, OA can be considered as mouthwash and exhibits outstanding performance for delivery of ICG dye; erupted molar structures could be observed at a short imaging time (<1  min) and low ICG dose (0.05  mg  /  kg).

CONCLUSIONS

Overall, ICG-NIRF with mouthwash could perform in-vivo dental imaging in two NIR wavelengths at a short time and low ICG dose.

Visual or visual-tactile examination to detect and inform the diagnosis of enamel caries

BACKGROUND

The detection and diagnosis of caries at the initial (non-cavitated) and moderate (enamel) levels of severity is fundamental to achieving and maintaining good oral health and prevention of oral diseases. An increasing array of methods of early caries detection have been proposed that could potentially support traditional methods of detection and diagnosis. Earlier identification of disease could afford patients the opportunity of less invasive treatment with less destruction of tooth tissue, reduce the need for treatment with aerosol-generating procedures, and potentially result in a reduced cost of care to the patient and to healthcare services.

OBJECTIVES

To determine the diagnostic accuracy of different visual classification systems for the detection and diagnosis of non-cavitated coronal dental caries for different purposes (detection and diagnosis) and in different populations (children or adults).

SEARCH METHODS

Cochrane Oral Health's Information Specialist undertook a search of the following databases: MEDLINE Ovid (1946 to 30 April 2020); Embase Ovid (1980 to 30 April 2020); US National Institutes of Health Ongoing Trials Register (ClinicalTrials.gov, to 30 April 2020); and the World Health Organization International Clinical Trials Registry Platform (to 30 April 2020). We studied reference lists as well as published systematic review articles.

SELECTION CRITERIA

We included diagnostic accuracy study designs that compared a visual classification system (index test) with a reference standard (histology, excavation, radiographs). This included cross-sectional studies that evaluated the diagnostic accuracy of single index tests and studies that directly compared two or more index tests. Studies reporting at both the patient or tooth surface level were included. In vitro and in vivo studies were considered. Studies that explicitly recruited participants with caries into dentine or frank cavitation were excluded. We also excluded studies that artificially created carious lesions and those that used an index test during the excavation of dental caries to ascertain the optimum depth of excavation.

DATA COLLECTION AND ANALYSIS

We extracted data independently and in duplicate using a standardised data extraction and quality assessment form based on QUADAS-2 specific to the review context. Estimates of diagnostic accuracy were determined using the bivariate hierarchical method to produce summary points of sensitivity and specificity with 95% confidence intervals (CIs) and regions, and 95% prediction regions. The comparative accuracy of different classification systems was conducted based on indirect comparisons. Potential sources of heterogeneity were pre-specified and explored visually and more formally through meta-regression.

MAIN RESULTS

We included 71 datasets from 67 studies (48 completed in vitro) reporting a total of 19,590 tooth sites/surfaces. The most frequently reported classification systems were the International Caries Detection and Assessment System (ICDAS) (36 studies) and Ekstrand-Ricketts-Kidd (ERK) (15 studies). In reporting the results, no distinction was made between detection and diagnosis. Only two studies were at low risk of bias across all four domains, and 15 studies were at low concern for applicability across all three domains. The patient selection domain had the highest proportion of high risk of bias studies (49 studies). Four studies were assessed at high risk of bias for the index test domain, nine for the reference standard domain, and seven for the flow and timing domain. Due to the high number of studies on extracted teeth concerns regarding applicability were high for the patient selection and index test domains (49 and 46 studies respectively). Studies were synthesised using a hierarchical bivariate method for meta-analysis. There was substantial variability in the results of the individual studies: sensitivities ranged from 0.16 to 1.00 and specificities from 0 to 1.00. For all visual classification systems the estimated summary sensitivity and specificity point was 0.86 (95% CI 0.80 to 0.90) and 0.77 (95% CI 0.72 to 0.82) respectively, diagnostic odds ratio (DOR) 20.38 (95% CI 14.33 to 28.98). In a cohort of 1000 tooth surfaces with 28% prevalence of enamel caries, this would result in 40 being classified as disease free when enamel caries was truly present (false negatives), and 163 being classified as diseased in the absence of enamel caries (false positives). The addition of test type to the model did not result in any meaningful difference to the sensitivity or specificity estimates (Chi²(4) = 3.78, P = 0.44), nor did the addition of primary or permanent dentition (Chi²(2) = 0.90, P = 0.64). The variability of results could not be explained by tooth surface (occlusal or approximal), prevalence of dentinal caries in the sample, nor reference standard. Only one study intentionally included restored teeth in its sample and no studies reported the inclusion of sealants. We rated the certainty of the evidence as low, and downgraded two levels in total for risk of bias due to limitations in the design and conduct of the included studies, indirectness arising from the in vitro studies, and inconsistency of results.

AUTHORS' CONCLUSIONS

Whilst the confidence intervals for the summary points of the different visual classification systems indicated reasonable performance, they do not reflect the confidence that one can have in the accuracy of assessment using these systems due to the considerable unexplained heterogeneity evident across the studies. The prediction regions in which the sensitivity and specificity of a future study should lie are very broad, an important consideration when interpreting the results of this review. Should treatment be provided as a consequence of a false-positive result then this would be non-invasive, typically the application of fluoride varnish where it was not required, with low potential for an adverse event but healthcare resource and finance costs. Despite the robust methodology applied in this comprehensive review, the results should be interpreted with some caution due to shortcomings in the design and execution of many of the included studies. Studies to determine the diagnostic accuracy of methods to detect and diagnose caries in situ are particularly challenging. Wherever possible future studies should be carried out in a clinical setting, to provide a realistic assessment of performance within the oral cavity with the challenges of plaque, tooth staining, and restorations, and consider methods to minimise bias arising from the use of imperfect reference standards in clinical studies.

Optical magnification has no benefits on the detection of occlusal caries lesions in permanent molars using different visual scoring systems: An in vitro study

Background

Some studies have addressed the influence of optical magnification on the detection of caries lesions using a visual scoring system. However, there is a lack of research related to the use of the CAST and ADA-CCS visual scoring systems. In addition, the reliability and accuracy of ADA-CCS index in permanent teeth were not studied yet. So, the aim of this study was to evaluate, in vitro, the influence of different levels of optical magnification on the detection of occlusal caries lesions in permanent molars using three visual scoring systems.

Material and Methods

One occlusal site per tooth was analyzed in 120 extracted permanent molars. Two trained examiners inspected the teeth using ICDAS (International Caries Detection and Assessment System), CAST (Caries Assessment Spectrum and Treatment), and ADA-CCS (American Dental Association-Caries Classification System) visual criteria, twice with each scoring system, with a one-week interval between examinations. The study was conducted in three phases: (A) without optical magnification, (B) using a binocular lens (3.5× magnification), and (C) using an operating microscope (16× magnification). Then, the teeth were sectioned longitudinally through the center of the selected site and the section with the more severe lesion was histological evaluated considering the D1 (lesions in enamel and dentin) and D3 (dentin lesions) thresholds.

Results

Kappa values for intra- and inter-examiner reproducibility were good to excellent for all systems. At the D1 threshold, sensitivity, accuracy, and area under the ROC curve were high for ICDAS and CAST in all phases. However, this was not the case for the ADA-CCS in phase C (<0.05). At the D3 diagnostic threshold, there was no significant difference between the visual scoring systems during the study phases (>0.05).

Conclusions

The magnification does not improve the accuracy of the visual scoring systems in the detection of occlusal caries lesions in permanent molars. Key words:Dental caries, caries detection, permanent teeth, visual examination, magnification.

Digital photography vs. clinical assessment of resin composite restorations

PURPOSE

To compare direct clinical and indirect digital photographic assessment of resin composite restorations. Ninety-two posterior resin composite restorations were classified using World Dental Federation (FDI) criteria by two different clinical examiners (C1 and C2). In the same appointment of clinical assessment, intraoral high-quality digital photographs were taken and posteriorly two different digital examiners (D1 and D2) classified the images of each restoration. Restorations of each patient were assessed once by C1 and C2 independently. D1 and D2 assessed the digital images from different locations and in different time. Data were analyzed using the Cohen's kappa coefficient, Kruskal-Wallis non-parametric test and Dunn's multiple shared test, with 95% confidence. Agreement levels varied from very good (0.81-1.00) to fair (0.21-0.40). Statistically significant differences (p < 0.05) between assessments were found for surface lustre, staining, color match and translucency, esthetic anatomical form, fracture of material and retention and marginal adaptation. The classification of the resin composite restorations varied significantly according to clinical or high-quality digital photographic assessments. Overall, clinical assessment detected more demand for repair or replacement.

Minimal invasive microscopic tooth preparation in esthetic restoration: a specialist consensus

By removing a part of the structure, the tooth preparation provides restorative space, bonding surface, and finish line for various restorations on abutment. Preparation technique plays critical role in achieving the optimal result of tooth preparation. With successful application of microscope in endodontics for >30 years, there is a full expectation of microscopic dentistry. However, as relatively little progress has been made in the application of microscopic dentistry in prosthodontics, the following assumptions have been proposed: Is it suitable to choose the tooth preparation technique under the naked eye in the microscopic vision? Is there a more accurate preparation technology intended for the microscope? To obtain long-term stable therapeutic effects, is it much easier to achieve maximum tooth preservation and retinal protection and maintain periodontal tissue and oral function health under microscopic vision? Whether the microscopic prosthodontics is a gimmick or a breakthrough in obtaining an ideal tooth preparation should be resolved in microscopic tooth preparation. This article attempts to illustrate the concept, core elements, and indications of microscopic minimally invasive tooth preparation, physiological basis of dental pulp, periodontium and functions involved in tool preparation, position ergonomics and visual basis for dentists, comparison of tooth preparation by naked eyes and a microscope, and comparison of different designs of microscopic minimally invasive tooth preparation techniques. Furthermore, a clinical protocol for microscopic minimally invasive tooth preparation based on target restorative space guide plate has been put forward and new insights on the quantity and shape of microscopic minimally invasive tooth preparation has been provided.

Magnification in endodontics: A review of its application and acceptance among dental practitioners

The application of magnification devices in endodontics is mainly meant for visual enhancement and improved ergonomics. This is crucial especially when long hours are spent in a narrow operating space to treat obscure microanatomy. Nevertheless, application of magnification in endodontics has yet to be introduced into the mainstream practice due to various influences in behavioral patterns. By conducting an extensive literature search in the PubMed database, this narrative review paper depicts the present state of magnification devices, their applications within the endodontic practice, factors that influence their usage, the advantages, and shortcomings, as well as the significances of magnification in the field of endodontics. This review paper will encourage clinicians to employ magnification in their practice for improved outcome.

Clinical applications of intraoral camera to increase patient compliance - current perspectives

Technological advancements in the field of dentistry have reformed the concept of photography as a powerful medium of expression and communication. It also offers a spectrum of perception, interpretation, and execution. One of the widespread clinical applications of computerization in dentistry today is the intraoral camera (IOC). It helps in the revelation of the hidden and overlooked defects in teeth and other parts of the cavity. Dental world constitutes of microstructures that have to be recorded in a detailed manner to perform patient education, documentation of records and treatment, illustration of lectures, publication and web connectivity of complicated cases. This review emphasizes the significant applications of IOC in dentistry and its possible impact on patient compliance for dental care.

Intraoral Camera Use in a Dental School Clinic: Evaluations by Faculty, Students, and Patients

The aims of this study were to assess the perceptions of dental students, faculty members, and patients about the benefits and pitfalls of intraoral camera use and to compare the completion rate of treatment planned posterior crowns with and without intraoral camera use in a predoctoral dental clinic. From July 2016 to June 2017, all 60 fourth-year dental students at one U.S. dental school were encouraged to use the intraoral camera in treatment planning with patients in the school clinic. Perceptions of the students, their patients, and the faculty members supervising the treatment planning were assessed with a survey at the end of the treatment planning appointment. The completion rate of treatment planned posterior crowns was determined by recalling all posterior teeth that were treatment planned for a single unit crown at a specific period of time compared to the number of the same crowns completed for the same patients at a specific period of time, using the electronic health record, with and without camera use. Of the 60 students, 51 completed 198 surveys (85% response rate); 35 faculty members completed 64 surveys, and 202 patients completed one survey each (response rates for those groups could not be calculated). The survey results suggested that the students, faculty, and patients viewed intraoral camera use in a positive way. However, faculty perceptions were a little lower than those of patients and students, and a significant number of faculty members were neutral. The completion rate of posterior planned crowns was significantly higher (p=0.0005) when intraoral cameras were used to present images to patients than when cameras were not used. In this study, intraoral camera use in a predoctoral clinic was perceived positively by students and patients but more neutrally by faculty, and it increased the completion rate of planned posterior crowns.

Minimal intervention dentistry II: part 1. Contribution of the operating microscope to dentistry

The different aspects of treatment of periodontal disease and mucogingival defects all require an accurate diagnosis in addition to good control and precision during therapeutic procedures. Magnification aids and microsurgery, combined with minimally invasive techniques, can best meet these requirements. The suitability of treatment, the healing time, pain levels and postoperative scarring are all improved and the patient benefits.

Performance of a light fluorescence device for the detection of microbial plaque and gingival inflammation

OBJECTIVES

The hypothesis to be tested was that using the SOPROCARE system in fluorescence perio-mode allows scoring of microbial plaque that is comparable to the Turesky modification of the Quigley Hein plaque index (T-QH) and scoring of gingival inflammation comparable to the Silness and Löe gingival inflammation index (GI).

MATERIALS AND METHODS

Fifty-five subjects with various amounts of microbial plaque were recruited. The T-QH and GI index were recorded. SOPROCARE pictures were recorded in fluorescence perio-mode and in daylight mode. Finally, conventional digital photographs were taken. All pictures were assessed using the same criteria as described for the clinical indices.

RESULTS

The average T-QH was 1.1 ± 1.2 (mean ± SD). Scoring with SOPROCARE perio-mode led to a slightly higher average than the T-QH scores. SOPROCARE daylight mode and digital photography showed the highest plaque scores. The average GI index was 0.7 ± 0.9. SOPROCARE in perio-mode scored slightly lower. Linear regression fits between the different clinical indices and SOPROCARE scores were significantly different from zero demonstrating high goodness of fit.

CONCLUSIONS

The study demonstrated that the SOPROCARE fluorescence assessment tool in perio-mode allows reliable judgment of microbial plaque and gingival inflammation levels similar to the established Turesky-modified Quigley Hein index and the Silness and Löe gingival inflammation index. Training on plaque-free teeth will actually reduce scoring errors.

CLINICAL RELEVANCE

The SOPROCARE fluorescence tool in perio-mode provides reliable evaluation of microbial plaque and gingival inflammation for the dental clinician.

Impact of low level magnification on incipient occlusal caries diagnosis and treatment decision making

INTRODUCTION

This in-vitro study aimed to test the accuracy and reproducibility in detection of incipient occlusal caries and treatment decision making using unenhanced visual-tactile technique and low level magnification by the use of loupes and surgical operating microscope (SOM).

METHODOLOGY

Sixty extracted human posterior teeth were assessed by two examiners using ICDAS- II index and CPI- TN probe, with and without magnification. Histopathology was used as gold standard for diagnosis of caries and treatment decision making. Inter and intra examiner reproducibility was determined using Kappa statistics.

RESULTS

Intraobserver reproducibility for caries detection using surgical operating microscope ranged from average to good (0.4-0.63). Inter-examiner reproducibility values for treatment decision making using experimental techniques such as unaided (0.40), Loupes (0.51) & SOM (0.63) were similar.

Evaluation of Dental Restorations: A Comparative Study Between Clinical and Digital Photographic Assessments

The aim of this study was to compare the efficacy of a direct clinical evaluation method with an indirect digital photographic method in assessing the quality of dental restorations. Seven parameters (color, occlusal marginal adaptation, anatomy form, roughness, occlusal marginal stain, luster, and secondary caries) were assessed in 89 Class I and Class II restorations from 36 adults using the modified US Public Health Service/Ryge criteria. Standardized photographs of the same restorations were digitally processed by Adobe Photoshop software, separated into the following four groups and assessed by two calibrated examiners: Group A: The original photograph displayed at 100%, without modifications (IMG100); Group B: Formed by images enlarged at 150% (IMG150); Group C: Formed by digital photographs displayed at 100% (mIMG100), with digital modifications (levels adjustment, shadow and highlight correction, color balance, unsharp Mask); and Group D: Formed by enlarged photographs displayed at 150% with modifications (mIMG150), with the same adjustments made to Group C. Photographs were assessed on a calibrated screen (Macbook) by two calibrated clinicians, and the results were statistically analyzed using Wilcoxon tests (SSPS 11.5) at 95% CI. Results: The photographic method produced higher reliability levels than the direct clinical method in all parameters. The evaluation of digital images is more consistent with clinical assessment when restorations present some moderate defect (Bravo) and less consistent when restorations are clinically classified as either satisfactory (Alpha) or in cases of severe defects (Charlie). Conclusion: The digital photographic method is a useful tool for assessing the quality of dental restorations, providing information that goes unnoticed with the visual-tactile clinical examination method. Additionally, when analyzing restorations using the Ryge modified criteria, the digital photographic method reveals a significant increase of defects compared to those clinically observed with the naked eye. Photography by itself, without the need for enlargement or correction, provides more information than clinical examination and can lead to unnecessary overtreatment.

Comparison of caries detection methods using varying numbers of intra-oral digital photographs with visual examination for epidemiology in children

Background

This was a method comparison study. The aim of study was to compare caries information obtained from a full mouth visual examination using the method developed by the British Association for the Study of Community Dentistry (BASCD) for epidemiological surveys with caries data obtained from eight, six and four intra-oral digital photographs of index teeth in two groups of children aged 5 years and 10/11 years.

Methods

Five trained and calibrated examiners visually examined the whole mouth of 240 5-year-olds and 250 10-/11-year-olds using the BASCD method. The children also had intra-oral digital photographs taken of index teeth. The same 5 examiners assessed the intra-oral digital photographs (in groups of 8, 6 and 4 intra-oral photographs) for caries using the BASCD criteria; dmft/DMFT were used to compute Weighted Kappa Statistic as a measure of intra-examiner reliability and intra-class correlation coefficients as a measure of inter-examiner reliability for each method. A method comparison analysis was performed to determine the 95% limits of agreement for all five examiners, comparing the visual examination method with the photographic assessment method using 8, 6 and 4 intra-oral photographs.

Results

The intra-rater reliability for the visual examinations ranged from 0.81 to 0.94 in the 5-year-olds and 0.90 to 0.97 in the 10-/11-year-olds. Those for the photographic assessments in the 5-year-olds were for 8 intra-oral photographs, 0.86 to 0.94, for 6 intra-oral photographs, 0.85 to 0.98 and for 4 intra-oral photographs, 0.80 to 0.96; for the 10-/11-year-olds were for 8 intra-oral photographs 0.84 to 1.00, for 6 intra-oral photographs 0.82 to 1.00 and for 4 intra-oral photographs 0.72 to 0.98. The 95% limits of agreement were −1.997 to 1.967, -2.375 to 2.735 and −2.250 to 2.921 respectively for the 5-year-olds and −2.614 to 2.027, -2.179 to 3.887 and −2.594 to 2.163 respectively for the 10-/11-year-olds.

Conclusions

The photographic assessment method, particularly assessment of 8 intra-oral digital photographs is comparable to the visual examination method in the primary dentition. With the additional benefits of archiving, remote scoring, allowing multiple scorers to score images and enabling longitudinal analysis, the photographic assessment method may be used as an alternative caries detection method in the primary dentition in situations where the visual examination method may not be applicable such as when examiner blinding is required and in practice based randomised controlled trials (RCTs).

Factors affecting the detection and treatment of occlusal caries using the International Caries Detection and Assessment System

OBJECTIVE

To assess the variability in diagnosis and treatment of occlusal caries among dental practitioners in Kuwait using the International Caries Detection and Assessment System (ICDAS) criteria.

METHODS

A representative random sample of 156 dentists were interviewed. After completing a survey that included information about their gender, age, years in practice, place of practice, place of dental education, and specialty, practitioners examined four separately mounted molars (I-IV) for probable occlusal caries according to the ICDAS-II visual criteria. They were then asked to answer a set of questions related to their diagnosis and treatment of each tooth. The teeth were then histologically sectioned, and two independent investigators evaluated the depth of the caries according to Hintze and Wenzel's histologic criteria.

RESULTS

According to the histologic examination, tooth I and III had caries into enamel, while tooth II and IV had caries into dentin. About 50% of the participants diagnosed teeth with enamel caries as sound. About 60% of the participants correctly diagnosed teeth with caries extending into dentin. A restorative treatment modality was recommended for enamel caries by approximately 50% of the participants and for dentin caries by more than 80% of the participants. Dentists with a specialty in restorative dentistry had a tendency to underdiagnose enamel caries, while general practitioners and other specialists tended to overtreat enamel caries.

CONCLUSIONS

There was an evident variability in the diagnosis and treatment choices of occlusal caries among dentists working in Kuwait. Among the factors studied, the specialty of the participants was the only factor that had an effect on the participants' diagnosis and treatment of occlusal caries.

Recognition of root canal orifices at a distance – a preliminary study of teledentistry

The remote recognition of root canal orifices was tested on 50 images of endodontically accessed teeth acquired with an intra-oral camera. The images were stored on a laptop computer and were presented to 20 observers who marked the visible canal orifices using software which stored the canal locations in standard files. The marked positions were verified on histological slices. In 87% of the cases, the canal locations were marked correctly. Inter-observer reliability depended on the location of the reviewed root canal (kappa = 0.44–0.77). The detection rate was related to the professional experience of the observers. The maximum proportion of accurate detections was found for the observers with more than 10 years of professional experience. The minimum proportion of accurate detections, 79%, was by the observer with one year of experience. The results of the study suggest that remote recognition of root canals by experienced dentists can help younger colleagues in the detection of root canal orifices.

The use of a microscope for restorative treatment decision-making on occlusal surfaces

Using an operating microscope, this study assessed the effect of 16x magnification on the restorative treatment of posterior teeth and compared the results against an unaided visual examination in vitro. Three dentists examined 300 premolars and molars at different times using an unaided visual examination and an operating microscope at 16x magnification. The observers examined the occlusal surfaces of teeth according to a patient model and selected a treatment protocol based on the following scale: 0: No Active Care (NC); 1: Preventive Care (PC) and 2: Operative Care and Preventive Care (OC+PC) advised. According to the results, there was good intra-observer agreement and moderate interobserver agreement with both techniques. No significant difference was found between the treatment using an unaided visual examination and that using an operating microscope. The use of a microscope at 16x magnification did not aid in the restorative treatment decision-making on occlusal surfaces.

The efficiency of operating microscope compared with unaided visual examination, conventional and digital intraoral radiography for proximal caries detection

Objective. The purpose of this study was to evaluate the efficiency of operating microscope compared with unaided visual examination, conventional and digital intraoral radiography for proximal caries detection. Materialsand Methods. The study was based on 48 extracted human posterior permanent teeth. The teeth were examined with unaided visual examination, operating microscope, conventional bitewing and digital intraoral radiographs. Then, true caries depth was determined by histological examination. The extent of the carious lesions was assessed by three examiners independently. One way variance of analysis (ANOVA) and Scheffe test were performed for comparison of observers, and the diagnostic accuracies of all systems were assessed from the area under the ROC curve (A_z). Results. Statistically significant difference was found between observers (P < .01). There was a statistically significant difference between operating microscope-film radiography, operating microscope-RVG, unaided visual examination-film radiography, and unaided visual examination-RVG according to pairwise comparison (P < .05). Conclusion. The efficiency of operating microscope was found statistically equal with unaided visual examination and lower than radiographic systems for proximal caries detection.